Uncomplicated Peripheral neuropathy – Moderate
Management escalation pathway
- Withhold ICPI
- Initial observation reasonable vs direct iniation of prednisolone 0.5 to 1 mg/kg (if progressing, e.g. from mild)
- Pregabalin or duloxetine might be introduced for pain
- If no clinical improvement after 48h, manage as severe
- Consider Myasthenia Gravis, GBS or CIDP
- Only consider resuming ICPI after multidisciplinary discussion
Advice on steroid wean:
- Conversion from i.v. to oral steroids at clinician discretion once improvement is noted
- Suggested oral prednisolone taper for 4-8 weeks
- Consider PJP prophylaxis, vitamin D if > 4-weeks duration
Assessment and Investigations
- Consider EMG for lower moter neuron and/or sensory change
- Neurological consult
- Perform imagery to exclude local compression due to cancer progression
Abbrevations
CMV: Cytomegalovirus
CIDP: Chronic Inflammatory Demyelinating Polyneuropathy
GBS: Guillain Barré Syndrome
PJP: Pneumocystis Jirovei Pneumopathy
